Predictive ability of fine-needle aspirate cytology for incompletely resected mast cell tumor surgical sites.

The goal of this study was to evaluate whether fine-needle aspirate cytology of a previous surgical site was predictive of recurrence for incompletely excised mast cell tumors (MCTs). Electronic medical records were searched for dogs diagnosed with MCTs; those with histologically confirmed, incompletely resected MCTs evaluated by scar aspiration cytology within 60 days after surgery were included for analysis. Variables were compared between groups using Fisher's exact test and logistic regression. Twenty-nine cutaneous and 7 subcutaneous tumors were evaluated. Local recurrence, confirmed by either histopathology or cytology, occurred in 13.8% of cases. No significant differences were identified for any variables other than surgical site cytology status. The negative predictive value of surgical site aspirate cytology without residual mast cell tumor was 93.5%, with an overall predictive accuracy of 88.9%. For the dogs evaluated in this report, surgical site aspiration cytology was predictive of local disease control for incompletely resected MCTs.

Capacité prédictive de la cytologie d'aspiration à l'aiguille fine de sites de chirurgie de résection incomplète de mastocytomes. L'objectif de la présente étude était d'évaluer si la cytologie d'aspiration à l'aiguille fine d'un site chirurgical antérieur permettait de prédire une récurrence lors de l'excision incomplète d'un mastocytome (MCT). Les dossiers médicaux électroniques furent examinés pour trouver des chiens avec un diagnostic de MCT; ceux avec confirmation histologique d'un MCT avec résection incomplète évaluée par cytologie d'une aspiration de la cicatrice en dedans de 60 jours après la chirurgie furent inclus pour analyse. Les variables furent comparées entre les groupes en utilisant le test exact de Fisher et une régression logistique. Vingt-neuf tumeurs cutanées et sept tumeurs sous-cutanées furent évaluées. Une récurrence locale, confirmée par histopathologie ou cytologie, est survenue dans 13,8 % des cas. Aucune différence significative ne fut détectée pour les différentes variables autres que le statut de la cytologie du site chirurgical. La valeur prédictive négative de la cytologie d'une aspiration du site chirurgical sans cellule résiduelle du mastocytome était de 93,5 % avec une précision prédictive globale de 88,9 %. Pour les chiens examinés dans cette étude, la cytologie d'une aspiration du site chirurgical était prédictive d'une maîtrise locale de la maladie lors de résection incomplète d'un MCT.(Traduit par Dr Serge Messier).

Selection of a Child Clinical Outcome Measure for Statewide Use in Publicly Funded Outpatient Mental Health Programs.

OBJECTIVE: This study describes the process of choosing a clinical outcome measure for a statewide performance outcome system for children receiving publicly funded mental health services in California. METHODS: The recommendation is based on a five-phase approach, including an environmental scan of measures used by state mental health agencies; a statewide provider survey; a scientific literature review; a modified Delphi panel; and final rating of candidate measures by using nine minimum criteria informed by stakeholder priorities, scientific evidence, and state statute. RESULTS: Only 10 states reported use of at least one standardized measure for outcome measurement. In California, the most frequently reported measures were the Child and Adolescent Needs and Strengths (CANS) (N=33), the Child Behavior Checklist (N=14), and the Eyberg Child Behavior Inventory (N=12). Based on modified Delphi panel ratings, only the Achenbach System of Empirically Based Assessment, the Strengths and Difficulties Questionnaire, and the Pediatric Symptom Checklist (PSC) were rated on average in the high-equivocal to high range on effective care, scientific acceptability, usability, feasibility, and overall utility. The PSC met all nine minimum criteria for recommendation for statewide use. In its final decision, the California Department of Health Care Services mandated use of the PSC and CANS. CONCLUSIONS: There is a lack of capacity to compare child clinical outcomes across states and California counties. Frequently used outcome measures were often not supported by scientific evidence or Delphi panel ratings. Policy action is needed to promote the selection of a common clinical outcome measure and measurement methodology for children receiving publicly funded mental health care.

Characteristics of inpatient thyroid surgery at US academic and affiliated medical centers.

OBJECTIVE: Describe data from patients undergoing thyroid surgeries for benign and malignant disease at US academic medical centers. STUDY DESIGN: Retrospective, database search. SETTING: The University Health System (UHC) Consortium (Oak Brook, Illinois) data compiled from discharge summaries. SUBJECTS AND METHODS: Discharge data were collected from the first quarter of 2002 through the fourth quarter of 2009. Searching strategy was based on diagnosis of thyroid disease and patients undergoing thyroid surgery across all UHC facilities. Demographic information was collected as well as length of stay (LOS) and costs. Complications were evaluated in this analysis. RESULTS: During the study period, 68,014 thyroidectomies were performed, with 27,200 for thyroid cancer. During the same period 6365 neck dissections were performed, with 1539 as stand-alone procedures. Total thyroidectomy was the procedure of choice for malignant disease. More total thyroidectomies and fewer hemithyroidectomies were being performed for benign thyroid disease in the inpatient setting. Almost all postoperative complications were more frequent after surgery for cancer except myocardial infarction and aspiration pneumonia. On average, LOS was longer for benign disease, but costs were higher for malignant disease. CONCLUSION: This is the largest series reporting inpatient LOS and mortality for thyroid surgery. The limitation of this study is that it reports patients whose stays were more than 23 hours, leaving out a significant number of thyroid surgeries that are performed as outpatients. Although the results contribute greatly to characterizing inpatient surgery, the results may not reflect current US trends for thyroid surgery.

High throughput methodology for synthesis, screening, and optimization of solid state lithium ion electrolytes.

A study of the lithium ion conductor Li(3x)La(2/3-x)TiO(3) solid solution and the surrounding composition space was carried out using a high throughput physical vapor deposition system. An optimum total ionic conductivity value of 5.45 × 10(-4) S cm(-1) was obtained for the composition Li(0.17)La(0.29)Ti(0.54) (Li(3x)La(2/3-x)TiO(3)x = 0.11). This optimum value was calculated using an artificial neural network model based on the empirical data. Due to the large scale of the data set produced and the complexity of synthesis, informatics tools were required to analyze the data. Partition analysis was carried out to determine the synthetic parameters of importance and their threshold values. Multivariate curve resolution and principal component analysis were applied to the diffraction data set. This analysis enabled the construction of phase distribution diagrams, illustrating both the phases obtained and the compositional zones in which they occur. The synthetic technique presented has significant advantages over other thin film and bulk methodologies, in terms of both the compositional range covered and the nature of the materials produced.

Arkansas BAHA experience: transcalvarial fixture placement using osseointegration surgical hardware.

OBJECTIVE: To determine what factors increase the likelihood of osseointegration failure and implant extrusion with the use of osseointegration surgical hardware, for bone-anchored hearing aids (BAHAs), in children and adults. PATIENTS: A total of 60 patients (42 pediatric [≤19 yr] and 18 adult patients [34-69 yr]) who received osseointegration surgical hardware for a BAHA at Arkansas Children's Hospital from October 2003 to May 2009 or at the University of Arkansas for Medical Sciences from November 2005 to May 2009, respectively. INTERVENTION: BAHA placement using 3- and 4-mm fixtures. MAIN OUTCOME MEASURES: Osseointegration failure with implant extrusion. RESULTS: Fifty-seven loaded fixtures in the pediatric population, and 20 were placed in the adults. We had a 21% pediatric and 0% adult osseointegration failure rate. CONCLUSION: Young age, syndromic status, and failure to penetrate the inner table of the cranium increased the risk of osseointegration failures in children. In some cases, skull thickness provides an inadequate amount of bone for 4-mm fixture placement requiring placement of a 3-mm fixture instead. In these cases, transcalvarial placement of the implanted fixture may decrease the extrusion rate as 3-mm fixtures have been associated with increased rates of implant extrusion. The 3-mm fixtures that were placed in a transcalvarial fashion had a decreased extrusion rate compared with 3-mm fixtures that were surrounded by bone and did not penetrate the inner table of the cranium. Individual patient factors out of the surgeon's control likely play a large role in osseointegration failures as well. This clinical case report encourages transcalvarial fixture insertion when using 3-mm fixtures during placement of osseointegration surgical hardware for BAHAs.

High-throughput synthesis and screening of ternary metal alloys for electrocatalysis.

We report the application of a new method for the high-throughput synthesis and screening of thin film materials and its application to the discovery of electrocatalysts. Results are presented for the PtPdAu ternary alloy system with respect to activity for oxygen reduction. The results reveal an enhancement in activity for a range of PtPd alloy compositions over either of the pure elements. An optimum composition range of ternary alloys with significant activity was also identified. A correlation was also investigated between the surface reduction potential and the activity for oxygen reduction in both binary and ternary alloys. The results demonstrate the potential of the methodology for the discovery and optimization of electrocatalysts for a wide range of applications.

Combinatorial electrochemical screening of fuel cell electrocatalysts.

Combinatorial methods have been applied to the preparation and screening of fuel cell electrocatalysts. Hardware and software have been developed for fast sequential measurements of cyclic voltammetric and steady-state currents in 64-element half-cell arrays. The arrays were designed for the screening of high-surface-area supported electrocatalysts. Analysis software developed allowed the semiautomated processing of the large quantities of data, applying filters that defined figures of merit relevant to fuel cell catalyst activity and tolerance. Results are presented on the screening of carbon-supported platinum catalysts of varying platinum metal loading on carbon (and thus, particle size) in order to demonstrate the speed and sensitivity of the screening methodology. CO electro-oxidation, oxygen reduction, and methanol oxidation on a series of such catalysts reveal clear trends in characteristics and activities. Catalysts with smaller particle sizes reveal structure in the CO stripping voltammetry that can be associated with edge sites in addition to the closely packed planes, and this is concomitantly reduced as particle size is increased. Specific activity for steady-state methanol oxidation and oxygen reduction at room temperature in H(2)SO(4) electrolyte is found to be a maximum for the largest particle sizes, in agreement with the literature. These trends in activity are significantly smaller than the differences in activities of promoted platinum-based alloy catalysts for the same reaction.